APPLICATION cum APPRAISAL MEMO FOR FINANCIAL ASSISTANCE OF

`____ LAKH
UNDER COVID-19 STARTUP ASSISTANCE SCHEME (CSAS)

Name of applicant
Constitution Pvt Ltd / Public Ltd (closely held)
Registered Office
Location of existing facilities
Date of incorporation
Date of Commencement of
business
Start-up Registration Details
Name of the Recommending
AIF

PART A: Founders/ Business

1. COMPANY PROFILE (Brief history and activities of the applicant company)

2. Founders/ promoters

Name (Age) Experience/background/ other concerns associated

Edu with
qualification

3. Product details
 Technical details of the company’s products, their maturity status
 Whether products have any IPR value
 Any product certifications/ accreditations
 Product comparison with other players

4 Management set up / Financial position/ statutory compliances

4.1Management team
[Brief details of important responsibility areas like finance, marketing,
production, technology, etc. being managed by founders or key
professionals]

Name Key functional Past experience

area responsible
for

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4.2 Structure of Board of Directors:

Representing Profile
Name

PART B: Financial position

5. Financial performance of company/ Associate concerns:
5.1 Financial performance/ position of company
(Rs lakh)

(A) Projections as per original business plan before Covid-19

FY18 FY 19 FY 20 (E) FY21 FY 22 FY 23

(Actuals) (Actuals (P) (P) (P)
)
Income
EBIDTA
Deprn
Interest
PAT
EBIDTA %
PAT %

Equity Cap
Pref Cap
Reserves
Networth
Secured
loans
Unsecured
loans
Receivable
s o/s
Current
assets
Current
liab.
Total
Collections

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 (B) Revised Projections on account of Covid-19 (for projections)

FY18 FY 19 FY 20 FY21 (P) FY 22 FY 23

(Actuals) (Actuals) (E) (P) (P)
Income
EBIDTA
Deprn
Interest
PAT
EBIDTA %
PAT %

Equity Cap
Pref Cap
Reserves
Networth
Secured
loans
Unsecured
loans
Receivable
s o/s
Current
assets
Current
liab.
Total
Collections

5.1.1 Brief comments on

o Revenue trends (main revenue streams)
o Profitability
o Liquidity (receivables, current assets, etc.)
o Cash and bank balance as on date of loan application and cash
runway for business sustainability based on estimated cash burn
o Effects of COVID 19 of the business prospects of the Company and
steps taken by the Company to meet these challenges
o Measures taken by the Company to ensure employee safety and
their financial stability

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 o Are any of the existing investors willing to invest additional funds to
manage the temporary liquidity crunch on account of Covid-19
o Are there any funding commitments from existing or new investors
that have been withdrawn or deferred due to Covid-19
o Details of all recevables overdue more than 90 days or expected to
cross 90 days in following format :

Name Amou Overd Reaso Steps Amount Expecte

of nt o/s ue n for taken by expecte d
Custom (lakh) since overdu compan d to be timeline
er (no. Of e y for recover of
days) collectio ed collecti
ns on
Custom
er A
Custom
er B

5.1.2 Shareholding pattern/ External Investment in the Company

Fully diluted shareholding pattern

Category Instrumen Shareholder % holding Amount

t details Invested (lakh)
Investors Equity
Shares
Investors Preference
Shares
Total 100% XX

 Comments on shareholding pattern (Valuation/ dilution in case of external

investments)

5.1.3 Banking facilities of applicant company

Institution Facilit Date of Sanc (o/s RoI Security
y sanctio Amt )

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 n
a)
a)

5.1.4 Adverse auditor’s remarks, if any-

5.1.5 Contingent liability, if any, and its impact or possibility of
devolvement during the tenure of the loan/ facility
5.1.6 Arrears of statutory dues, if any –

5.2 Associate concerns (business & financial performance):

Name Founder Activity
(location) associate
d
FY 18 FY 19 FY 20
(P)
Sales
PAT

Comments on performance of associate concerns

6. Status of compliances

6.1 Full details of disputed liabilities of the enterprise towards statutory

payments like income tax, GST, PF, etc., if any, to be provided.

6.2 Details of arrears in statutory payments like income tax, GST, PF, etc., if
any, to be provided.
6.3 Details of GST refunds awaited.

7. Cibil & Legal

Comment on Cibil score and performance of Founders and Company

Comment if any legal cases open relating to Founders and Company

PART C : Funding sought from SIDBI

8. Proposed venture rationale
Rationale and need for additional funding from SIDBI
Benefits flowing to the company
9. Proposed use of funds from SIDBI (details at Annexure )
Amount of funding sought
Proposed use of funds
Repayment Period and moratorium sought

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10. Selling Plans to achieve the business targets

11.Manpower/ technical preparedness

12.Any other approvals required for the new business targets

13.SWOT Analysis of company

Strength

Weaknesses

Opportunities

Threats

PART D :
CERTIFICATIONS/COMPLIANCES
(To be certified by the Directors/ Managing Director of the Company)

14. STATUTORY APPROVALS FOR RUNNING THE BUSINESSES

We certify that the details of all the statutory, technology, quality, IPR, etc
related approvals/ consents/ permissions required for running the business and
implementing the fresh venture plan are as under:

Sl. Particulars Approving Status Expected

No Institution/ timeline for
. Authority approval
1 Statutory
approvals
2 Technology
approvals
3 Quality Approvals
4 Others

15. I/We hereby certify that:

a) all information furnished by me/ us above and in the Business Plan/ appendix/
annexures/ statements and other papers enclosed are true;
b) I/We have perused the RBI guidelines on Connected lending and certify that
the provision of Connected Lending guidelines do not apply in the instant
case.
c) I/we have no borrowing arrangements for the unit with any bank/FI except as
indicated in the application;
d) there are no overdues/ statutory dues/ government enquiry/ proceedings/
prosecution against the unit/ associate/ group concerns/ promoters/ directors/
partners/ proprietor except as indicated in the application;
e) no legal action has been/is being taken against the unit/ associate/ group
concerns/ promoters/ directors/partners/ proprietor except as indicated in the
application;

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f) None of our promoters / partners/ proprietor/ directors/ managers/ employees
/ guarantors and/or any of their relative(s) is/are Director(s) in SIDBI or any of
the Scheduled Banks/FIs and/ or related to any Senior Officer(s) of SIDBI.
g) I/We confirm that none of our units/associates/group
concerns/promoters/directors /partners/ proprietor has/ have defaulted to any
bank/FI.
h) I/We shall furnish all other information that may be required by SIDBI in
connection with my/our application for financial assistance;
i) I/We have no objection to SIDBI furnishing the information submitted by
me/us to other banks / FIs/ CIBIL/ any agency as you may deem fit in
connection with consideration of my/our application for financial assistance.
j) I/We have no objection to SIDBI/its representatives making necessary
enquiries/verifications while considering my/our application for financial
assistance.

Encl: As above

Place:
Date:
Signature
(Rubber Stamp)
Name & Designation

We confirm that the contents of the above application are true and
correct to the best of our information. We confirm having invested in
the above Start-up company and recommend the application for
sanction of assistance from SIDBI.

For ________________________________(Name of AIF)

(Authorised Partner)

Place:
Date:

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 Guidelines for submission of the Application to
SIDBI

Ÿ Application as per format to be submitted alongwith the checklist of

documents.

Ÿ Only verifiable information to be mentioned in the application alongwith

the source of information.

Ÿ Wherever any information/document in the application is not applicable,

the same needs to be mentioned as “NA” alongwith the reason for the same.

Ÿ The application must address all the issues mentioned in the format.

Ÿ Wherever figures are in currency other than INR, the same to be

converted into INR for consistency.

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 List of Annexures to Application

I. Promoter’s CVs and Networth Statements

II. Analysis of past financial statements
III. Particulars of proposed Venture Outlay
IV. Projected financial statements (revised factoring in Covid-19 impact)
a. Projected profitability statement
b. Projected cash flow statement
V. Associate Concerns details
VI. RBI format for multiple banking arrangement

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 LIST of documents to be submitted along with application

Sl Documents Enclosu Docume

re No nts not
enclose
d
1 Promoters and Guarantors –
1. Bio-data and Networth Statement (as per
1 attached format)
1. Photographs/ signatures attested by bankers
2
1. Copies of passport/ PAN card/ aadhar card etc.
3
1. 3 yrs ITR and wealth tax returns
4
1. Net Worth statement
5
2 Applicant company
2. DPIIT Registration details / Copy of MSME
1 registration/ EM under MSMED Act
2. Certified copies of KYC documents like MAOA/
2 Partnership deed, PAN allotment letter, Copy of
Telephone Bill etc.
2. Atleast 2 yrs audited financial statements of the
3 enterprise and associate concerns with auditor’s
report, notes to accounts and tax audit report.
2. Provisional b/sheet and P&L of the enterprise as
4 on a latest date
2. Latest 2 year ITR and Sales tax return, copy of
5 latest receipt for advance tax paid. Copy of IT
assessment orders for past 2 years.
2. Copies of registration with statutory authorities
6 viz GST, EPF, etc
2. Copies of other statutory approvals obtained
7
3 Applicant company
3. Copies of sanction letters for credit facilities
1 from Banks, if any.
3. Bank statement of all bank accounts for past 12
2 months.
3. Copy of the latest CMA data submitted to WC
3 banker, if any.
4 Copy of Pollution Control Board approval for
existing and proposed units (if applicable)
5 Copy of sale/ lease deed/ rental agreement

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